2006-072 - Laserfiche WebLink

Home Browse Search

PAYMENT APPLICATION Page 1 TO: Indam River County PROJECT IRC Discharge Outlet and Rip R - APPLICATION It 3 Distribution to: 2640 25th Street NAME AND Discharge Outlet & Rip Rap Spillway LOCATION: PERIOD THRU: 12/16/2005 � OWNER Vero Beach FL BID # 6069 PROJECT #s: [ ARCHITECT FROM: Timothy Rose Contracting, Inc ARCHITECT: DATE OF CONTRACT: 11 /17/2004 ❑ CONTRACTOR 1360 Old Dixie Hwy SW ❑ Vero Beach, FL 32962 ❑ FOR: India River County CONTRACTOR'S SUMMARY OF WORK Contractors signature below is his assurance to Owner, concerning the payment herein applied for, that: (1 ) the Work has been performed as required in the Contract Documents, (2) all sums Application is made for payment as shown below. previously paid to Contractor under the Contract have been used to pay Contractor's costs for labor, Continuation Page is attached. - - _ materials and other obligations under the Contract for Work previously paid for, and (3) Contractor is legally entitled to this payment. 1 . CONTRACT AMOUNT $106,735.00 CONTRACTOR: n10 ac " , Inc. 2. SUM OF ALL CHANGE ORDERS $8,350.00 By Date: 'ZAC 3. CURRENT CONTRACT AMOUNT (Line 1 +/- 2) $115,085.00 Timothy Rose/ 4. TOTAL COMPLETED AND STORED $115,085.00 State of: Florida (Column G on Continuation Page) County of: Indian River v Pus MORGAN SMRH 301919 5. RETAINAGE: Subscribed and sworn to before + c h W COMM153 � 2008 a. 0.00% of Completed Work $0.00 me this day of �r �� r s P S.6,1T1 Bud9dNd'ry X03 (Columns D + E on Continuation Page) v� ^'rangy' b. 0.00% of Material Stored $0.00 Notary Public: Morgan Smith (Column F on Continuation Page) My Commission Expires: March 21 , 2008 //�� rr ;;� Total Retainage (Line 5a + 5b or �LIU L Column I on Continuation Page) $0.00 ARCHITECT'S CERTIFICATION 6. TOTAL COMPLETED AND STORED LESS RETAINAGE $115,085.00 Architect's signature below is his assurance to Owner, concerning the payment herein applied for, (Line 4 minus Line 5 Total) that: (1 ) Architect has inspected the Work represented by this Application, (2) such Work has been 7. LESS PREVIOUS PAYMENT APPLICATIONS $0.00 completed to the extent indicated in this Application, and the quaility of workmanship and materials conforms with the Contract Documents, (3) this Application for Payment accurately states the amount (Line 6 from prior Application) of Work completed and payment due therefor, and (4) Architect knows of no reason why payment 8. PAYMENT DUE $115,085.00 should not be made. 9. BALANCE TO COMPLETION CERTIFIED AMOUNT.................................... .......... ........................................... (Line 3 minus Line 6) $0.00 (If the certified amount is different from the payment due, you should attach an explanation. SUMMARY OF CHANGE ORDERS ADDITIONS DEDUCTIONS Initial all the figures that are changed to match the certified amount.) � Total changes approved in ARCHITECT: previous months $8,350.00 $0.00 BY Date: Total approved this month $0.00 $0.00 TOTALS $8,350.00 $0.00 Neither this Application nor payment applied for herein is assignable or negotiable. Payment shall be made only to Contractor, and is without prejudice to any rights of Owner or Contractor under NET CHANGES $8,350.00 the Contract Documents or otherwise. PAYMENT APPLICATION OSS , INC. DOCUMENT